Ebola survivor I, Senga Omeonga: 'Every day I’m still thinking: When was I contaminated?'

Senga Omeonga comes from the Democratic Republic of the Congo (DRC), the country that had the first recognized Ebola outbreak in 1976 and where the virus was discovered. Omeonga, a medical doctor, also received Ebola training in DRC, but he saw his first case this summer in Monrovia, the capital of Liberia, where he has lived for the past 3 years.

And then Omeonga, who worked at St. Joseph’s Catholic Hospital—not a specialized Ebola treatment center—contracted the disease himself. He was one of a handful of people worldwide to receive ZMapp, an experimental antibody cocktail.

Omeonga’s family lives in Canada, and when he became ill, he did not have any roommates. On 24 September, he spoke with Science about his experience, including his suspicions about how he became infected, and the epidemic now devastating Liberia, Guinea, and Sierra Leone. The following is an edited version of that conversation and subsequent e-mails that clarified a few details.

Q: Why do you think so many health care workers have become infected?

A: There’s a lot we need to learn. From my own experience, it’s really the lack of protective equipment in our hospitals in Liberia. Right now we are starting to have more. In the beginning, we didn’t have enough to protect ourselves as health care workers.

There were also problems with the patients we were receiving. A lot of them were lying when they come to the hospital. They didn’t even tell you they’re having fevers. They’d say they fell down or were on a motorbike, or someone pushed them, or they went to work and passed out. Sometimes you put a patient on a table to assess them and find out different symptoms.

Q: Did you have personal protective equipment (PPE)?

A: I had protective gear, the light PPE we use for the outpatient department. We had a surgical gown, gloves, and a face mask. No boots. I had just short gloves and they were some days not really fitting.

Q: How do you think you became infected?

A: I had to deal with a patient who initially was negative and we were treating him, and he had no improvement. They requested a second test and it came back positive after 10 days. I was exposed to that patient day by day. With light PPE. I don’t think I had enough protection in the hospital. Somehow I was contaminated by touching him.

Q: Did you have fluid touching you?

A: It’s hard to tell. He was a wet patient—he was having diarrhea and vomiting. Probably somewhere I touched him. At the time he was declared negative, I was sitting in his room talking to him and being close to him. I don’t really remember direct contact. Maybe the last few days when he was almost abandoned. Everyone was afraid to touch him. He was screaming. I removed his nasogastric tube and he was fighting. I had my face shield and mask on.

Maybe it was in the beginning, when I was sitting in his room. Sometimes I had just a T-shirt on. I don’t know. There are lots of questions. Every day I’m still thinking: “When was I contaminated?”

Q: Why do you single out that patient?

A: I saw three patients who were positive. Unfortunately they all died. After seeing the first two ones, I was quarantined, and I went through the 21 days and was not infected.

Q: When were you diagnosed as positive for Ebola?

A: I started feeling the symptoms on the second of August, a Saturday: high fever, vomiting, and weakness. I didn’t have diarrhea. It went on for 5 days before they could collect the specimen. At that time, the country had only one Ebola treatment unit [ETU] [at the ELWA 2 hospital]. They were really overwhelmed and it was really difficult to find a space. Even for me as a doctor. It was on Friday that they collected the specimen; on Saturday I learned I was positive and was taken to the ETU at ELWA 2.

Q: You were sick at home for week?

A: Yes. The house is just behind the hospital. It was a plus for me, because I had access to the medication, and nurses and people from the pharmacy helped me. I had oral rehydration salts and medication to stop the vomiting. By the day, the weakness was getting worse. In the first 3 days, I was able to manage, but after that, I needed help.

Q: Were you in denial?

A: Three days before my symptoms started, they came to pick up that patient from the hospital and take him to the ETU. Everyone who picked him up, all were worried. We were all living in the compound. They had to monitor us for 21 days. We were all checking our body temperatures. I did not check my temperature because I was so afraid. When I started having the fever, I knew I was infected.

Q: Were other people you work with infected by same patient?

A: Yes, the person who probably infected all of us was the hospital director, Brother Patrick Nshamdze, who unfortunately died on 2 August. In total two brothers, a Spanish priest, a sister, two nurses, one x-ray tech, one lab tech, and one social worker died. Two other doctors, two sisters, and one orthopedic tech survived. They closed the hospital after the outbreak.

Q: Did you think you were going to die?

A: Yes. The only thing that was coming was my death. I spoke with my wife and kids and we talked and talked and talked. They were very concerned. They were praying for me, encouraging me. It was a very big support. I was praying myself. I was having positive thoughts and started saying even if it was 10% chance for recovery I want to be among the 10%.

Q: You received ZMapp. Do you think it made a difference?

A: I think it helped, but I cannot say for sure. When I went to the Ebola treatment center, I was quite a little bit stable. I was walking. I was not like other patients who were very sick. I was not vomiting or having diarrhea. My own antibodies plus the ZMapp helped me for a speedy recovery. I had three doses and, unfortunately, I had a severe reaction to the medication on the third dose. I think it was a medical error: I did not receive the antiallergy medication they have to give before to minimize side effects.

Q: How come you were chosen to receive ZMapp?

A: I don't really know. I was just the luckiest one. At that time there were three doctors who were infected. And I think they gave the Liberian government ZMapp for doctors. One doctor came to my room and said we have ZMapp for three doctors. That’s how I happened to get it.

Q: Do you feel healthy now?

A: I feel fine. I still have symptoms, like my joints having a little pain every day. And the weakness is disappearing. I’m about 75%. I’m feeling much better. I’ll go back to work when I’m fully recovered.

Q: There’s a possibility that people who had the disease have immunity. What do you think?

A: I think I’m protected right now for the strain I had, but we still need to protect ourselves.

Q: Do you want to work in an ETU?

A: I don’t want to say I don’t want to work in an ETU. But I really don’t like the PPE. It’s very uncomfortable and I don’t think I can handle it. I’m not afraid. I have my immunity, but I continue to take my precautions.

Q: What do you think of the idea of having people who recovered from Ebola help with caring for patients?

A: Today we talked to the doctor in charge of ELWA 2, about this idea because there’s an acute shortage of staff. It doesn’t need to be health care workers. Non–health care workers can be trained, and those who recovered can be very helpful as patient assistants. They can give food and water and help the patient. The idea was welcomed but he needed to discuss this with health ministry and see if it’s willing to sponsor that kind of program and hire these people.

Q: What will happen now in Liberia?

A: Right now, with the Monrovia situation, contact tracing, just forget about it. They’re already lost. There’s a lot of contact in the community we don’t even know. The patients are going to the treatment centers and because there’s a lack of beds, they go back to the community and continue infecting people. We’re overwhelmed. Nobody is doing the contact tracing.

When they came to me and did the tests, nobody asked me for my contacts. I’m a doctor. I had a lot of patients I treated. There are too many cases and they don’t know the contacts. They’re out there in the community going to market and schools and whatever.

We just hope with the help of the international community, the U.S. government, and other governments and NGOs [nongovernmental organizations], this will be controlled. If we have to depend on the Liberian government, the situation is getting worse and worse and it will be disastrous. There are not enough human resources and financial resources.

For a story about Ebola's infection risk for health care workers, click here.